Indomethacin Decreases Post-ERCP Pancreatitis (Indomethacin)

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Endoscopic retrograde cholangiopancreatography (ERCP) is now a widely accepted therapy for treating benign and malignant diseases of the pancreatobiliary tree. Acute pancreatitis represents the most common and feared complication following ERCP. The reported incidence of this complication is from 1% to 40% according to the presence of high-risk factors for this complication or the presence dysfunction in the sphincter of Oddi (SOD). In most prospective series, the incidence has ranged between 3.5% and 20% for nonselected and high-risk patients, respectively. Independent risk factors for post-ERCP pancreatitis are either patient- or procedure-related.

Defined as the development of new or increased abdominal pain consistent with pancreatitis, and elevated blood amylase or lipase >3 times the upper limit of normal until 24 h after the procedure, and hospitalization (or prolongation of existing hospitalization) for at least 2 nights.

was determined according to consensus guidelines, with mild post-ERCP pancreatitis resulting in hospitalization of < 3 days, and moderate post-ERCP pancreatitis resulting in hospitalization of 4-10 days

Acute Pancreatitis [ Time Frame: During 30 days after hospital discharge. ]

Patients who developed Acute Pancreatitis after hospital discharge with presence of abdominal pain consistent with pancreatitis, and elevated blood amylase or lipase >3 times the upper limit of normal.

Asymptomatic hyperamylasemia [ Time Frame: 48 hours after procedue. ]

any amylase level at least three times above the normal serum level in the absence of abdominal pain.

Measurement of serum amylase [ Time Frame: 2 hours post-ERCP ]

measured in all patients right after procedure and during surveillance (3 hours).

Routine laboratory examinations [ Time Frame: 2 hours after procedure and daily until hospital discharge, an expected average of 10 days. ]

All laboratory exams were performed when acute pancreatitis of any etiology was established

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Layout table for eligibility information

Ages Eligible for Study:

18 Years to 65 Years (Adult, Older Adult)

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

No

Criteria

Inclusion Criteria:

If they met one or more of the following criteria:

a clinical suspicion of SOD dysfunction;

or a history of post-ERCP pancreatitis, pancreatic

or precut sphincterotomy,

more than eight cannulation attempts,

pneumatic dilatation of an intact biliary sphincter,

or ampullectomy

Patients were also eligible for inclusion if they met two of the following criteria:

aged 50 years or younger and female gender

or a history of recurrent pancreatitis (>2 episodes),

three or more injections of contrast agent into the pancreatic duct with at least one injection to the tail of the pancreas,

excessive injection of contrast agent into the pancreatic duct resulting in opacification of pancreatic acini,

or the need for acquisition of a cytology specimen from the pancreatic duct with the use of a tissue-sampling brush.

Exclusion Criteria:

unwillingness or inability to consent for the study

pregnancy

breast feeding

standard contraindications for ERCP

hypersensitivity to aspirin or NSAIDs

previous use of NSAIDs within 1 week

renal failure (creatinine clearance rate >1.4 mg/dL)

active or recent (< 4 weeks) gastrointestinal hemorrhage

chronic calcified pancreatitis

pancreatic head malignancy

any procedure performed on the major papilla/ventral pancreatic duct in patients with a pancreatic divisum

previous ERCP for biliary stent removal or exchange without an anticipated pancreatogram

subjects with prior biliary sphincterotomy and scheduled for repeat biliary therapy without an anticipated pancreatogram